We understand the need to obtain transparent pharmacy benefit management services which focus on cost containment while offering innovation clinical solutions. To discovery transparency we focus on the following 4 areas:
Pharmacy Benefit Manager Contract
It all starts with understanding your pharmacy benefit manager and the current prescription administrative services agreement. We review this agreement (i.e. PBM contract) and ensure transparency is built into the contract and that the financial terms meet or exceed national benchmarks.
Prescription Benefit Design
We review the current plan design to ensure equitable plan and member cost-share. During this process, we provide feedback and areas of opportunity which may result in plan savings while ensuring minimal member disruption. Additionally, we review plan specifications and discuss financial and clinical impacts of coverage for certain medication classes (e.g. lifestyle medications).
Prescription Plan Performance
A clinical pharmacist will review historical prescription claims data to gain an understanding of pharmacy spend unique to your plan. The goal of this review is to establish benchmark dashboards for consumption and comparison of national bench-marking. We work with you to have a crystal clear understanding of where your money is spent on the prescription benefit and to identify cost-savings strategies.
Prescription Benefit Manager Audits
We review prescription claims and the plan document to ensure the pharmacy benefit manager is administering the plan as intended. Intentional audits can lead to the discovery of incorrectly administered plans which may have resulted in additional costs to the employer. We identify these and work with the PBM to recover any monies due back to you as well as correcting identified errors in the plan design.
We have found this comprehensive strategy to save employers around 10% of prescription plan savings.
"An investment in knowledge always pays the best interest."--Benjamin Franklin